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What should you consider when choosing the right hospital and hospice program?

Choosing a hospital

When we choose a hospital, we assume that it will treat an illness or injury or, if we get to the point that we no longer want treatment, help us die with dignity and with as little pain as possible. We may not want “heroic measures.” They may look pointless and painful, like torture not treatment. But some hospitals, particularly Catholic hospitals, are committed to using artificial means to prolong a natural death.

Make sure that your Advance Directive to Physicians (“Living Will”) will be honored before you check in.

Instruct the agent under your Medical Power of Attorney to require that you be moved elsewhere if it is not.

Choosing a hospice program

When choosing a hospice program, be aware that not every Medicare insurer and every hospice program provides for all four levels of hospice. If you have a Medicare Advantage program, ask what it pays for. Ask a prospective hospice provider what levels of hospice they provide.

4 levels of hospice

“Routine level of care” allows you to be seen anywhere from daily to every 14 days by a hospice nurse, certified nursing assistant, chaplain or social worker.

“Respite care” allows you to stay in a skilled nursing home for up to five days to give the people who are caring for you at home a break.

“Continuous care” or “comfort care” puts a nurse at your bedside to manage pain symptoms and end-of-life care. It lets you die at home. Few hospices provide this. But it is what most of us want.

“General inpatient care” is provided by a Medicare-accredited hospital or skilled nursing facility with an R.N. on staff. It might keep you alive for your granddaughter’s wedding or to let a family member fly in to say goodbye.

Americans only average seven to eight days in hospice. We are eligible for hospice for renewable six month periods.

Would more time in hospice help? When would it help?

As we age, our bodies have a harder time taking in nutrition. A hospice stay can put us back on track.

Untreatable cancer (or cancer which we no longer want treated), congestive heart failure and chronic obstructive pulmonary disease can all be managed in hospice.

In end-stage dementia and some cancers, congestive heart failure and lung conditions which deprive the brain of oxygen, the brain no longer recognizes thirst or hunger or tells the throat muscles to swallow. This, too, can be managed in hospice.

Choosing the right hospital and the right hospice program can make all the difference.

The time to talk about end-of-life care is before we need it. Click here to read: Talking to Your Doctor About End-of-Life Care

Estate planning attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is active in the Texas and Austin Bar Associations. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.

She assists families of people with special needs, people planning for the retirement years and people administering estates.



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